Fed UP! – More Detestable Bureaucratism from the VA.

I-CareI hate being lied to!  More than I hate being lied to, I detest, with every fiber in my being bureaucrats and the inanity they promulgate to excuse their stupidity and throw a wrench into the works.  Today I suffered through yet another call with my VA-appointed primary care provider (PCP).  Not an online conference, but a phone call.  Who was in the office with the provider and why?  How can I guarantee my HIPAA information during a phone call on an unsecured line?  How do I know who I am talking to?  These concerns and more arise when you receive a phone call to discuss important medical information, and my PCP does not care!  My PCP refuses to use the VA’s tools to conduct patient appointments and instead creates workarounds; what an ingenious method for telling lies and spreading falsehoods as bureaucratic inertia; I’m so thrilled!

The PCP continuously claimed all my imaging is “normal” and “unremarkable.”  The pain experienced cannot be related, and the sources are questionable.  In polite speak, the PCP is trying to tell me it’s all in my head; a previous provider from the VA already used this as an excuse for not performing their job.  For more than 10-years, I have been fighting the VAHCS for help in reducing pain and in getting to root causes for the problems experienced.  Yet, today’s call was just more of the same BS wrapped in feel-good words, platitudes, and bureaucratic non-answers.  Honestly, after the third time the doctor related, the imaging was normal and unremarkable; I lost my cherub-like demeanor!  I did not swear until I got off the phone, but I am not anywhere close to a happy patient.

Honest question, does the VAHCS troll medical school for the bottom of the barrel, those people who can barely pass a class, let alone qualify for medical privileges?  I need competence, and I get useless lumps.  I ask questions, and the snowflakes pop out of the woodwork like ticks on a deer or fleas on a dog.  I am thoroughly sick of being treated like a know-nothing inconvenience.  The most important person in the VA marketed PACT Team is the patient who will be active, engaged, and informed.  The second most important member of the VA Marketed PACT team is the Primary Care Provider.VA 3

Since 2002 I have had a problem in my gastro-intestinal system; since 2010, the pain has been debilitating, and four years ago, I was diagnosed with non-alcoholic fatty liver disease.  Today, 22 March 2022, the PCP reviewed the problems area on my electronic health record (EHR), which coincidentally resides at the top of the electronic health record and was mentioned four different times by myself, and noted that non-alcoholic fatty liver disease is not listed.  Tell me, how would that make you feel?  The PCP ordered today’s call before the recent imaging appointment on my abdomen and pelvis, but the provider, who called me almost 30-minutes late, did not even look up my record before calling.  Had not studied the imaging results and formulated a plan of action to move forward, yet as the second most important member of the PACT team, I am supposed to trust this bureaucrat; I think NOT!

Through the miracle of modern technology, I had read and researched the imaging results more than 24 hours before the scheduled appointment to discuss the results.  I came prepared, but the provider could not be bothered to prepare for a call they demanded, then had the sheer effrontery to keep repeating that the imaging is “normal” and “unremarkable.”  Then the provider has the gall to tell me, repeatedly, that I was yelling, when in fact, she only did not like being spoken to with emphasis and insistence that she do her job!  Yes, I called her a bureaucrat and a snowflake, whereupon she threatened to hang up the call, but I disconnected first.  I miss those old rotary phones you leased from AT&T, they had heft, and when slammed, they made you feel better about disconnecting a call.PACT_model

From research, it is abundantly clear that pain from hernias can show up or be felt in areas far removed from the hernia site.  Constipation is both an indicator and a symptom of hernias.  Muscle weakness in the legs, burning sensations, and much more are all indicators of a hernia.  Yet, when I asked about all the other pains and problems experienced in my abdomen, I was told the hernia could not be the root cause, and the imaging is “normal and unremarkable,” but the PCP could not answer why these other symptoms are unrelated when asked.  Where is the research, seeing as “Dr. Google,” is discouraged; Johns Hopkins and the Mayo Clinic, plus I have access to the medical libraries at the University of Phoenix and Grand Canyon University.  With less than five minutes of research, I can locate and read data from reputable sources to form the basis of questions to ask a PCP, which is encouraged of patients by the VA.  Yet, the doctor cannot be trusted to provide any intelligent data, do any preparation, or knowledgeably speak to a symptom list; when will the VA answer why their PCP cannot do their job?PACT 1

If only I were the only person experiencing these problems and issues with the VA.

Former VA cardiologist John Giacomini of Atherton, California, pleaded guilty to one count of felony abusive sexual contact.  In the fall of 2017, Giacomini repeatedly subjected a subordinate electrophysiologist to unwanted and unwelcome sexual contact, including hugging, kissing, and intimate touching while on VA premises.  On 10 November 2017, the victim explicitly told Giacomini she was not interested in a romantic or sexual relationship with him.  Nevertheless, Giacomini continued to subject his subordinate to unwanted sexual advances and touching, culminating on 20 December 2017, when Giacomini turned out the lights in an office, pulled the victim out of her chair, and fondled her until a janitor opened the office door and interrupted the encounter.  The victim later resigned from her position at the VA, citing Giacomini’s behavior as her principal reason for leaving.  Sentencing is scheduled for 12 July 2022.VA 3

Will the VA-OIG troll through this former provider’s employment history seek out the other victims, or will this be swept under the rug not to tarnish the VA?  Having been an employee of the VA, will anyone, EVER, look at how employment law is abused by the leaders in the VA and correct the problems?  This incident should never have occurred, nor should it have taken years of abuse to end this despicable behavior.  Yet, what does the VA do, shut both eyes and pretend it does not occur in consequence of the designed culture at the VA.

Why did the victim have to tell another adult that their behavior was unwanted, and quit their job, before the VA took action?  Will there be an inquiry from congress?  Will any lawyers stand up and demand the VA correct this detestable hole that allows this behavior to promulgate?  I am not holding my breath!

Speaking of electronic medical health records, the VA-OIG has issued three separate reports on this topic, and none of them paint the VA with anything that shows competence.  In the report titled:

Medication Management Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VAMC in Spokane, Washington.”  The following findings were related:

Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficult—all of which can affect patient care and safety.  Areas of concern included:

(1) Data migration
(2) Medication formulary availability
(3) Medication order processing
(4) Provider notification and alerts
(5) Controlled substance tracking
(6) Prescription drug monitoring program documentation
(7) Medication reconciliation
(8) Medication list accuracy.”VA 3

As previously stated, I am not as nice and never politically correct.  VA-OIG, please allow me to correct your assertion, “Deficiencies in medication data migration and management resulted in patients having inaccurate or incomplete medications in their records or made filling prescriptions accurately more difficultall of which DO negatively affect patient care and safety.”  Trust is the first casualty in war and in dealing with the VA in ANY form, manner, or method.  When you cannot trust your data to remain confidential, the entire electronic medical record system can only be rated as UNACCEPTABLE!  The upgrading of the electronic medical records system at the VA is a 10-year, multi-billion-dollar fiasco, and as a taxpayer, I am done paying for this system!

Not to be outdone by the medication side of veteran care experiencing failures, the following VA-OIG report was issued:

Care Coordination Deficiencies after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The EHR rollout caused problems in coordinating veterans’ care, ranging from the flags for patients at high risk for suicide not transferring to veterans and their care providers having trouble accessing video appointments and patient portal messaging.  Tracking outcomes were sometimes lost, and disappearing laboratory orders also resulted.  Although the OIG did not identify associated patient deaths, future deployment of the new EHR without resolving identified deficiencies could increase risks to patient safety.”VA 3

Again, the VA-OIG is practicing political correctness instead of being specific, and upfront, the entire EHR is a disaster, the cost is prohibitive, and any fool should see it is time to pull the plug, cut the losses, and hold the leadership accountable!  Yet, what do we see; the EHR is progressing into infinity and beyond at a snail’s pace!

The final nail in the VA’s EHR coffin should be that nobody involved can communicate with the IT helpdesk for the EHR as the IT ticketing system is unreliable!  Form the VA-OIG, we find the following:

Ticket Process Concerns and Underlying Factors after the New Electronic Health Record Go-Live at the Mann-Grandstaff VA Medical Center in Spokane, Washington.”

The failure to process and respond to VHA staff ticketing requests for help or report concerns resulted in reporting, tracking, and resolving problems.  These deficiencies made it difficult for clinicians and administrative staff to serve patients and impeded EHR fixes that can affect future sites.  The inspection team also identified five factors contributing to the deficiencies identified in the two companion reports above: usability, training, interoperability, needed fixes, and problem resolution.”VA 3

Imagine for a moment, you are responsible for a multi-billion-dollar IT project, and one of the first issues discovered by the users is the inability to reach out for IT help; how long would you remain employed?  Would you ever expect to ever work again if any of these problems were your legacy for leading the IT improvement on a multi-billion-dollar project?  As a consultant, I know how fast you would be fired and taken to court for business losses.  Why are these leaders exempt?  Where are the blue-ribbon panels and committees demanding people be held accountable for this fiasco?EHR-VA-OIG

When the VA-OIG casually mentions that PCPs are untrustworthy and not using the current tools correctly, should the providers be issued new tools; NO!  Yet, this is the opposite of what common sense declares.  Are you, dear reader, as a taxpayer, fed UP yet?  My wife reminds me, “These problems happen in civilian hospitals.”  No, in fact, they do not.  If data migrated from one patient’s EHR to another patient’s HER, that hospital would be sued and shut down so fast by congress at the federal and state level, all before the media firestorm would have barely begun.  If a patient were jeopardized because their provider could not track medications, that patient would sue for malpractice and possibly a class-action lawsuit.  If an IT project was occurring in the civilian world, and the users could not contact the IT helpdesk, the project would be overhauled so fast, and people fired, new records would have been set.

Knowledge Check!It is time we end this charade and money pit call the Department of Veterans Affairs, and every other agency of the Federal government bloat!  The government should be leading, not lagging, where operational efficiency and fiscal sanity are concerned.  I repeat, only for emphasis, are you fed UP yet?

© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

NO MORE BS: Enthusiasm and Confidence – The Power Tools to Conquer

Laughing OwlIn a job interview, the interviewer asked me for my two greatest strengths and why.  The following article represents both my answer and my desire to see others understand.  The interviewer thought I was insane by the look of disgust on their face; needless to say I was not hired.  When I asked why; the answer amazed me.  My strengths were too strong for their culture.  Let that sink in for a moment; a confident and enthusiastic person was not a good fit for their organization.  Maybe, just maybe, free societies should be taking a new look at these age-old tools for changing the world.

What is Enthusiasm?

Henry Chester is quoted as saying, “Enthusiasm is the greatest asset in the world. It beats money and power and influence. It is no more or less than faith in action.”  As a point of fact, this is the first quote I took time and a ton of energy to memorize.  Enthusiasm represents intense interest, eagerness, enjoyment, and a desire for approval beyond the simple desire of peer acceptance.  Enthusiasm also arouses feelings and originates via Latin from enthusiasmus, meaning inspiration and frenzy.  From the Greek, we learn the etiology of Enthusiasm stems from “enthousiazein ‘be inspired or possessed by a god’ (based on theos ‘god’)”  The etiology of Enthusiasm makes Henry Chester’s point more perfectly when a person considers the power and origination of faith and placing faith upon a power greater than oneself.

Literary FiendConsider those people you have found possessing large amounts of Enthusiasm; can you feel their intensity, frenzy, and eager interest?  I have had this pleasure multiple times, in various locations across the world.  My first experience was with a S. Korean business person riding the subway who was so excited to help and interested that I parted company with a feeling of desiring to be better as a person.  From that day in 1995 to today, I have strived to capture the same level of Enthusiasm as this business person in gratitude for his kindness and example of Enthusiasm.

What are you enthusiastic about?

Recently I was hired to be a data analyst for warehouses, and I sit as an advisor to the warehouse operations team to use data analysis to improve decision-making.  I cannot describe in words how enthusiastic I am every day to wake up and learn something new about data analysis, the tools of database data mining, and keeping my boots dirty and hands greasy in operations.  Ever since I got injured in the US Navy, I have tried to be what I knew, and the journey to this position has been great and dreadful, but each experience has improved how I think, and teach, to improve business operations.  I finally feel I can positively contribute as a handicapped person to the world with this position, and this feeling is incredible!Leadership Cartoon

What is Confidence?

In an effort to not confuse this topic, I have copied the definition of confidence from an earlier writing.  Confidence is a unique term, and Webster spends an inordinate amount of time trying to capture the power of, and reality is confidence.  Confidence is “a feeling of self-assurance arising from one’s appreciation of one’s own abilities or qualities; firm trust, a specific feeling  regarding the truth of something, a feeling or belief upon the reliance of someone or something.”  The key to confidence is your own self-assurance.  For example, you are assured through past transactions that your employer is not kiting paychecks.  Your confidence in receiving a salary drives you to be motivated and return to work each day.  When that trust is broken, you will leave and find new employment.  Hence, people do not work for companies, but for managers and leaders, they like.

ToolsConfidence is a reality when many people all trust the same thing, which creates societies, social standards, and governments.  Confidence in the government is expressed using the government’s monetary system to trade for products and services you would not have if you had less confidence in the government system.  Firm trust in the “value of the US Dollar (insert your own currency here)” leads to gains and losses in economic values.  Consider the events of the Christmas Holiday, which is fast approaching.  The individual expresses confidence, faith, and hope in holiday shopping.  The government uses the data of the volume of trades of confidence as a measuring stick in how well they are doing in government to improve a person’s return on investment.  Shopkeepers, stores, and others selling products and services represent a two-way street of faith, hope, and confidence as they trade with customers and with other suppliers, government, and stakeholders in conducting business.

Confidence is never an unconscious decision!  One cannot have firm trust, faith, or hope, in something without being consciously aware and possessing experience and knowledge in that someone or something.  Hence, confidence is the conscious use of trust as a destination in the journey of hope, launched by faith.Grit is a Marathon

What are you confident about?

In the movie “Sound of Music,” Maria sings one of my all-time favorite songs as she leaves the nunnery and takes a bus to her new  role as a nanny, “I Have Confidence.”  I can honestly say, as she does, “I have confidence in me.”  I have talents, skills, knowledge, and experience worth value to me, and that is all I need!  It did not matter to me that my Enthusiasm and confidence were too great for the interviewer’s culture and business; I interviewed my best and allowed the chips to fall where they may.  What are you confident about?  Who are you confident in?  Why do you invest your confidence in those answers?  When do you feel the most confident, and would you like to feel more confident?

Of all the questions asked, the “Why” and the When” questions are some I would love to discuss individually as you make your improvement plans.  Since this is not entirely possible, I offer the following advice from LaRae Quy, an FBI Agent.  The points are hers; the comments are mine.Non Sequitur - Decisions

  1. Take Risks!
    1. In my youth, I climbed trees, lots and lots of trees. In Maine, we had a patch of pine trees growing so close together, the trees had woven a mat out of their uppermost branches, and you could walk on this mat of branches.  Huge risk, great fun!
    2. As a soldier, I was freaked out by how close the Warthog could provide fire support. When the ‘Hog came through, being on the ground was the most intense feeling I have ever experienced.  Huge risk, lots of fun.
    3. As an operations manager, I took an ill-considered risk. I fired the floor supervisor as they refused to train anyone else in doing the jobs they were hired for as a means of job security.  The risk paid off; the remaining team members stepped up to the plate and learned.
    4. Risk requires action; act swiftly, even if it means minor course corrections along the way.
    5. Action includes failure; stop fearing failure! When we understand failure, we know ourselves just a little better and act more smartly!
    6. When in doubt, activate step 5!Bound & Gagged - Near Death
  2. Ask for feedback!
    1. Do you prefer to receive feedback from friends, family, or foes? Some of all, all or none, or something or someone else?
    2. Do you trust those providing feedback sufficiently to act?
    3. Can you tell the difference between feedback and criticism? They are not the same, and in accepting feedback, you need to be able to give feedback.  Hence ask, but never forget to provide feedback.
    4. Never give criticism, even if you think the criticism is “constructive.” There is never, ever, anything “constructive” about criticism!Frank & Ernest - Life Lesson
  3. Practice, Practice, Practice
    1. Missoula Montana, I presume he is retired now, Veteran Employment Specialist, Charlie Brown, genuine person, real name, had a favorite axiom for helping veterans search for work and hang in their job search, “Keep throwing spaghetti at the wall until something sticks!”  Which is all well and good, but to get spaghetti to stick to a wall, you must first cook and drain the spaghetti.  Thus, practice requires preparation.  In case anyone is interested, yes; I have thrown spaghetti against a wall.
    2. Rule of 6-P’s, “Proper Prior Planning, Promotes, Promising, Practice,” is my saying, and I know it works. Practice is a prerequisite to promising performances, but you must prepare properly.  Yes, as a dual-service veteran, I know the other axioms for the Rule of 6-P’s.
    3. See Suggestion 5! Wash, rinse, and repeat!Garfield - Good Explanation Needed
  4. Link up!
    1. Network.
    2. Make acquaintances.
    3. Get to know people!Non Sequitur - This explains so much
  5. Grit Up!
    1. I cannot stress this enough; confidence and Enthusiasm require grit! Lots and lots of grit!
    2. Believe this statement: “Merentur Melius Quam Tu tibi semper sit.” From Latin, meaning, “You will always be better than you deserve.”Grit - Defined
    3. What is “Grit,” you might ask? Grit is a positive, cognitive trait based on an individual’s perseverance of effort combined with the passion for a specific long-term goal or end state.  At least, that is what the academics call grit.  Of all the people America remembers who have had a positive and long-lasting influence upon American culture, John Wayne is near the top.  If anyone embodies grit, John Wayne is quoted thusly, “True grit is making a decision and standing by it, doing what must be doneNo moral man can have peace of mind if he leaves undone what he knows they should have done.”  In understanding grit, I have oft called upon T. S. Eliot, “Only those who will risk going too far can possibly find out how far one can go.”

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.